Join Early Retirement Today
Closed Thread
 
Thread Tools Search this Thread Display Modes
Old 10-02-2014, 06:55 PM   #41
Recycles dryer sheets
 
Join Date: Oct 2010
Posts: 392
Fuego

If you BIL pays more than 9.5% of his pay towards his contribution to employer provided healthcare, he can drop that healthcare, and apply through the exchange and get subsidy. I just researched this for my son - his company was acquired and has an expensive plan with almost no deductible, raising his portion to more than double what he paid before.
__________________

__________________
BellBarbara is offline  
Join the #1 Early Retirement and Financial Independence Forum Today - It's Totally Free!

Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you'll find that Early-Retirement.org is a great community to join. Best of all it's totally FREE!

You are currently viewing our boards as a guest so you have limited access to our community. Please take the time to register and you will gain a lot of great new features including; the ability to participate in discussions, network with our members, see fewer ads, upload photographs, create a retirement blog, send private messages and so much, much more!

Old 10-02-2014, 06:57 PM   #42
Recycles dryer sheets
 
Join Date: Oct 2010
Posts: 392
Living in Mass, let me say it is widely accepted and well received. It did take a number of years to get that uninsured number down (I think it's still at 5% but I am too lazy to look it up). We are only a year in with ACA, the longer we go on, more will sign up. I wish congress would improve things, but it will not happen anytime soon.
__________________

__________________
BellBarbara is offline  
Old 10-02-2014, 07:14 PM   #43
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Feb 2013
Posts: 5,326
Quote:
Originally Posted by John Galt III View Post
I asked beforehand how much I would have to pay for a blood test. Answer from ins co was "five dollar copay, that's it". Got the bill, and there was an extra charge on it, for $7, for the "phlebotomy" (blood draw). Haven't summoned the will to call the ins co yet about it (endless BS, on hold forever, etc) since it only a $7 ripoff.
That sounds like the medical equivalent of "resort fees":

Hidden hotel fees gaining exposure - Chicago Tribune

Or a vet I went to once that added on a "room use" fee after I, too, had taken the time to call around and rate shop.
__________________
daylatedollarshort is offline  
Old 10-02-2014, 08:35 PM   #44
Full time employment: Posting here.
 
Join Date: Aug 2005
Posts: 942
i could not pull up link that the OP posted, so not sure if this one is different

http://www.nytimes.com/2014/09/29/us...e=article&_r=0

Here's an article that talks about the "assistant surgeon" problem.
http://www.nytimes.com/2014/09/21/us...ills.html?_r=0

Seems like we are really suffering from provider ethics in this country.
__________________
modhatter is offline  
Old 10-02-2014, 09:21 PM   #45
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Nov 2007
Posts: 7,526
Quote:
Originally Posted by pb4uski View Post
Just thinking out loud here, but in scenario 1 would your BIL be better off getting single coverage through his employer and an exchange plan for the remainder of the family? Would someone like your MIL in scenario 2 qualify to buy catastrophic coverage since the cost of the lowest bronze plan is unaffordable (> 8% of income)? (Our unsubsidized cat coverage is $213/month). On scenario 3 your parents just need to go through the process or visit healthsherpa.com and it should tell them what a plan would cost them if they retired but you're right that it is hard to fix ignorance unless they are willing to explore their options.
My BIL has "affordable" insurance, therefore his household is ineligible for ACA exchange subsidies because he's covered by workplace insurance.

My MIL could get exchange insurance without subsidy but I think it's closer to $350/mo for anything reasonable. Catastrophic for her would be paying $5-10k+ out of pocket under a catastrophic plan (that's all she's got sadly enough though partly through no fault of her own - she's a refugee who came here later in life). Paying $350/month is money she doesn't have. So like many uninsured, her plan A for major medical issues is emergency room and treatment and then bankruptcy or if the ambulance takes her to the right hospital, getting the hospital and doctor's fees waived through the state's charitable health care program (IIRC <250% FPL gets fees waived if you meet certain criteria).

As for my parents, I agree they just need to go through the process. They aren't ignorant people (engineer and teacher with advanced degrees, etc) but I guess they've heard ACA is on uneasy footing and it's horrible for America so often that they believe it on some level even though it could benefit them greatly. I think they are also in OMY status and my father is hoping to make it 3 more years to medicare eligibility. Unlike me ( ) they're also a bit old fashioned about receiving gubmint benefits and might not want to line up at the gubmint feeding trough a la ACA.
__________________
Retired in 2013 at age 33. Keeping busy reading, blogging, relaxing, gaming, and enjoying the outdoors with my wife and 3 kids (5, 11, and 12).
FUEGO is offline  
Old 10-02-2014, 09:24 PM   #46
Thinks s/he gets paid by the post
 
Join Date: May 2008
Posts: 3,417
Quote:
Originally Posted by modhatter View Post
i could not pull up link that the OP posted, so not sure if this one is different

http://www.nytimes.com/2014/09/29/us...e=article&_r=0

Here's an article that talks about the "assistant surgeon" problem.
http://www.nytimes.com/2014/09/21/us...ills.html?_r=0

Seems like we are really suffering from provider ethics in this country.
One of the original links showed that emergency room doctors saw their pay increase from $240k to $310k in the last 4-5 years.

I think there are consultants at work, teaching them how to maximize revenues, hot to optimize taxes, etc. Like the idea to set themselves up as an independent contractor in the first place.

Some elective fields of medicine, like cosmetic surgery, probably has similar conferences and workshops teaching surgeons on business models.
__________________
explanade is online now  
Old 10-02-2014, 09:29 PM   #47
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Nov 2007
Posts: 7,526
Quote:
Originally Posted by BellBarbara View Post
Fuego

If you BIL pays more than 9.5% of his pay towards his contribution to employer provided healthcare, he can drop that healthcare, and apply through the exchange and get subsidy. I just researched this for my son - his company was acquired and has an expensive plan with almost no deductible, raising his portion to more than double what he paid before.
The way I understand it is that if his portion of premiums for his "self-only" insurance is more than 9.5% of AGI, then it's unaffordable and he can drop it. But the family coverage can exceed 9.5% and that doesn't matter, since the employer is still providing the employee (but not employee and his family) affordable coverage. Hence the reason I cite this as a real problem under the ACA. You have a guy making maybe $40k/yr including some overtime and paying around 20-22% toward HI premiums for the family.

But if the rule has changed or been reinterpreted, please let me know because it'll save BIL a ton of cash!
__________________
Retired in 2013 at age 33. Keeping busy reading, blogging, relaxing, gaming, and enjoying the outdoors with my wife and 3 kids (5, 11, and 12).
FUEGO is offline  
Old 10-02-2014, 09:33 PM   #48
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Nov 2007
Posts: 7,526
Quote:
Originally Posted by John Galt III View Post
Agree there are still many "gotchas" used by insurance companies AND providers to scoop more cash from the patients. Latest example : I asked beforehand how much I would have to pay for a blood test. Answer from ins co was "five dollar copay, that's it". Got the bill, and there was an extra charge on it, for $7, for the "phlebotomy" (blood draw). Haven't summoned the will to call the ins co yet about it (endless BS, on hold forever, etc) since it only a $7 ripoff.
My insurance usually won't pay the $7 extra BS charges like that. They'll have a footnote on the EOB that says "this charge is customarily included in the charge for the main procedure (blood test in this case) and will not be reimbursed separately as it is a duplicate charge".

We get charged a couple hundred bucks for the kid's immunizations, then occasionally an extra $30-40 "immunization admin charge" and the ins. co. always calls BS on that charge to administer the immunization (the 3 minutes to fill the syringe, swab the arm, and poke it in by the nurse or nurse's assistant, oh, and slap a bandaid on).
__________________
Retired in 2013 at age 33. Keeping busy reading, blogging, relaxing, gaming, and enjoying the outdoors with my wife and 3 kids (5, 11, and 12).
FUEGO is offline  
Old 10-02-2014, 10:19 PM   #49
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
pb4uski's Avatar
 
Join Date: Nov 2010
Location: Vermont & Sarasota, FL
Posts: 16,407
Quote:
Originally Posted by FUEGO View Post
My BIL has "affordable" insurance, therefore his household is ineligible for ACA exchange subsidies because he's covered by workplace insurance.....
Quote:
Originally Posted by FUEGO View Post
The way I understand it is that if his portion of premiums for his "self-only" insurance is more than 9.5% of AGI, then it's unaffordable and he can drop it. But the family coverage can exceed 9.5% and that doesn't matter, since the employer is still providing the employee (but not employee and his family) affordable coverage. Hence the reason I cite this as a real problem under the ACA. You have a guy making maybe $40k/yr including some overtime and paying around 20-22% toward HI premiums for the family. ....
I guess what I was thinking is that even if BIL doesn't qualify for subsidies, if he and his family are relatively healthy they might be better off with a catastrophic plan then paying 20-22% for HI. Alternatively, perhaps he could take his employer's plan for himself only (since the employer subsidizes it heavily) and his wife/kids could get their own cat or bronze plan through the exchange and it might still be less than insuring the whole family through his employer.

In the end, we need to totally divorce HI from employment to get rid os such inequities.
__________________
If something cannot endure laughter.... it cannot endure.
Patience is the art of concealing your impatience.
Slow and steady wins the race.
pb4uski is offline  
Old 10-02-2014, 11:00 PM   #50
Thinks s/he gets paid by the post
Katsmeow's Avatar
 
Join Date: Jul 2009
Posts: 3,393
Quote:
Originally Posted by ERhoosier View Post
Did she consent to have an "assisting surgeon"? Was the need for 2nd surgeon due to a surprising new finding or an emergency situation? Was the procedure so complex that it routinely would require a 2nd surgeon? If not, I would think she would be justified in telling the 2nd surgeon to buzz off and dispute/refuse the bill. Or threaten to sue the second surgeon for assault, since (apparently) that she had not consented to have him/her touch her or even be in the OR during her surgery.
That said, for most procedures I've had the pre-op consent says something to the effect that I was consenting to have 'whateversurgery' performed by or under the direction of 'Dr. X'. IIUC, to ensure that Dr X actually does the surgery you must modify that consent clause to state specifically that you consent to have ONLY Dr X perform the procedure unless there is an emergency or specific unforeseen circumstances. If I were traveling cross-country for surgery I would make damn sure this issue was crystal clear before I even left home.
The problem you run into in one I ran into a few years ago (so this is all pre-ACA). I was having surgery and I wanted to make sure everyone was in network. The doctor and hospital were. But, the hospital said that none of the anesthesiologists were in network nor would the assistant surgeon be in network. (The assistant surgeon was required by the hospitla). This was because the anesthesiologists and assistant surgeons were not in any network. So I looked into going to another hospital. However, the same group of anesthesiologists and assistant surgeons provided those services to all the hospitals in the area.

What really irritated me was when the assistant surgeon billed something like 10x what insurance paid the actual surgeon. The policy we had did provide that the insurer would treat the anesthesiologist and radiologist and a couple of other provides as in network and reimburse at that rate rather than the out of network rate. I also got the insurer to agree to pay the assistant surgeon at the in network rate.

Of course, the issue that could have come up was that the insurer paid them the same discounted rate they would have paid an in network doctor. I was worried that these out of network providers would try to come after me for the difference, but they didn't.

Still it was so annoying since there was literally no one that was in network for those services.
__________________
Katsmeow is offline  
Old 10-03-2014, 02:00 AM   #51
Full time employment: Posting here.
 
Join Date: Aug 2005
Posts: 942
And we wonder why our insurance costs here in America are out of control.
__________________
modhatter is offline  
Old 10-03-2014, 06:08 AM   #52
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
travelover's Avatar
 
Join Date: Mar 2007
Posts: 9,874
Quote:
Originally Posted by Katsmeow View Post
The problem you run into in one I ran into a few years ago (so this is all pre-ACA). I was having surgery and I wanted to make sure everyone was in network. The doctor and hospital were. But, the hospital said that none of the anesthesiologists were in network nor would the assistant surgeon be in network. (The assistant surgeon was required by the hospitla). This was because the anesthesiologists and assistant surgeons were not in any network. So I looked into going to another hospital. However, the same group of anesthesiologists and assistant surgeons provided those services to all the hospitals in the area.

What really irritated me was when the assistant surgeon billed something like 10x what insurance paid the actual surgeon. The policy we had did provide that the insurer would treat the anesthesiologist and radiologist and a couple of other provides as in network and reimburse at that rate rather than the out of network rate. I also got the insurer to agree to pay the assistant surgeon at the in network rate.

Of course, the issue that could have come up was that the insurer paid them the same discounted rate they would have paid an in network doctor. I was worried that these out of network providers would try to come after me for the difference, but they didn't.

Still it was so annoying since there was literally no one that was in network for those services.
I think that this sums it up nicely. We basically have an ongoing situation whereby even sophisticated consumers are being held hostage by certain greedy medical providers and Congress absolutely refuses to intervene.
__________________
Yes, I have achieved work / life balance.
travelover is offline  
Old 10-03-2014, 11:46 AM   #53
Full time employment: Posting here.
 
Join Date: Aug 2014
Posts: 555
Quote:
Originally Posted by travelover View Post
I think that this sums it up nicely. We basically have an ongoing situation whereby even sophisticated consumers are being held hostage by certain greedy medical providers and Congress absolutely refuses to intervene.
But flip the situation the other way-- should the medical staff be forced to work at a wage the government or an insurance company sets if they want to practice medicine?

I think the mess is because we have become disconnected from the costs of care. Getting this straightened out is going to be painful whichever way we go. And the problem goes very deep--Costs to educate doctors are as inflated as any degree if not more so. Residents are overworked and under paid and they need to be compensated for all those years as well. Countries without socialized medicine have found ways to do it cheaper and even turn a profit but its not just a healthcare problem. Tort reform, health insurance that is not really insurance, education costs, billing issues, etc all play into it.
__________________
ArkTinkerer is offline  
Old 10-03-2014, 01:02 PM   #54
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
travelover's Avatar
 
Join Date: Mar 2007
Posts: 9,874
Quote:
Originally Posted by ArkTinkerer View Post
But flip the situation the other way-- should the medical staff be forced to work at a wage the government or an insurance company sets if they want to practice medicine?

I think the mess is because we have become disconnected from the costs of care. Getting this straightened out is going to be painful whichever way we go. And the problem goes very deep--Costs to educate doctors are as inflated as any degree if not more so. Residents are overworked and under paid and they need to be compensated for all those years as well. Countries without socialized medicine have found ways to do it cheaper and even turn a profit but its not just a healthcare problem. Tort reform, health insurance that is not really insurance, education costs, billing issues, etc all play into it.
I see your point, but when the assisting surgeon wants to get paid 10X what the primary surgeon is paid, that rate is not agreed upon ahead of time and the patient may have no alternative anyway, we have a major problem.

A major issue is that the charging system is deliberately opaque, especially to the patient, who used to not care. Now that the patient has more skin in the game with co-pays and deductibles, the medical industry wants to continue on with this hide the real charges game. That is where we need legislation to protect the patient.
__________________
Yes, I have achieved work / life balance.
travelover is offline  
Old 10-03-2014, 01:37 PM   #55
Full time employment: Posting here.
 
Join Date: Aug 2014
Posts: 555
Quote:
Originally Posted by travelover View Post
I see your point, but when the assisting surgeon wants to get paid 10X what the primary surgeon is paid, that rate is not agreed upon ahead of time and the patient may have no alternative anyway, we have a major problem.

A major issue is that the charging system is deliberately opaque, especially to the patient, who used to not care. Now that the patient has more skin in the game with co-pays and deductibles, the medical industry wants to continue on with this hide the real charges game. That is where we need legislation to protect the patient.
I'm sure the primary surgeon would like to be paid 10X as well! But I do agree. To me the two primary points are 1) "have no alternative" and 2) "charging system is deliberately opaque". The first issue is due almost entirely to the government limiting the number of residency slots and regulating the number of hospitals. Of course its exacerbated by the desire for profits from our for-profit and non-profit (yep, people make lots of money with non-profits!) hospitals. But then, how can you compete if you have to pay your resident physicians and other hospitals get theirs courtesy of the feds? The opaque is probably somewhat due to a history of customers not caring but I grant that a lot of it may be providers not wanting to show their cards. Trying to compare "list" cost with what providers really pay is near impossible. Some of that is changing. Our insurance at w*rk allows us to see the costs of procedures at all surrounding facilities. DW has gotten very good at calling and checking on prescription prices. More work for us but it has saved substantial $$$ over the last few years.
__________________
ArkTinkerer is offline  
Old 10-03-2014, 02:39 PM   #56
Moderator
Walt34's Avatar
 
Join Date: Dec 2007
Location: Eastern WV Panhandle
Posts: 16,501
Thank you all for a thoughtful discussion.

__________________

__________________
I heard the call to do nothing. So I answered it.
Walt34 is offline  
Closed Thread


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
ACA when one has no income and is living off of after tax cash reserves Tandemlovers Health and Early Retirement 65 09-03-2013 11:06 AM
WiFi All In One Printer - which one to buy Disappointed Other topics 18 05-09-2013 07:35 PM
Healthcare ACA subsidies appear to depend on multi-year income pixelville FIRE and Money 21 03-14-2013 10:01 PM
One Down & One to Go! Col. Klink Hi, I am... 12 07-26-2011 07:05 PM

 

 
All times are GMT -6. The time now is 01:07 AM.
 
Powered by vBulletin® Version 3.8.8 Beta 1
Copyright ©2000 - 2017, vBulletin Solutions, Inc.